ASM Sc. J., Special Issue 2017(1) ICT-Bio, 83–45

A Video-based Education and Analysis System
for Professional Caregivers of Cognitive
Impaired Elderlies
Miwako Honda, MD1, Shogo Ishikawa2, Yusuke Okino3, Atsushi Nakazawa3, Yoichi Takebayashi2, Candida
Delmas4, Rosette Marescotti5 and Yves Gineste5

BackgroundIn the rapid growth of an aging society, The behavioural psychological symptoms of dementia (BPSD)
management is one of the key challenges.
Objectives
To evaluate the differences between conventional care and Humanitude® care, and to verify the validityof the analysis by informatics on the professional caregiver’s performance to dementia patients.
MethodThe French-originated multimodal comprehensive care methodology; Humanitude® was compared toconventional care. Oral care and walking assistance for the same patients were evaluated by different
care methodologies. The care provided was video-recorded and analysed by three elements ofcommunication modalities: eye contact, verbal communication, touch, as well as the comprehensivenessof the modalities. Analysis was done manually by researchers of artificial intelligence and automaticallyusing informatics analytical software.
Results
Two caregivers who performed multimodal care methodology and two caregivers who performed
conventional care were enrolled in the study. Communication elements: eye contact, verbal
communication and touch during the oral care were 0%, 20%, 0% by conventional care and 38%, 35%,50% by Humanitude® respectively. In walking assistance, eye contact, verbal communication and touch
were 0%, 40%, 0% by conventional care and 13%, 22%, 36% by Humanitude® respectively. There
was a significant difference in the two groups (p<0.05). The comprehensiveness, to perform more than
two modalities of care simultaneously, also showed significant differences. Auto-video analysis by an
informatics software had the same output as manual analysis.
Conclusions
There was significant difference in the three care modalities and its comprehensiveness when compared
between Humanitude® and conventional care. Auto-video analysis would be effective on standardised
training for caregivers and would reduce the training cost.
Director of Geriatric Research Division, National Hospital Organisation Tokyo Medical Centre, 2-5-1 Higashigaoka, Meguro,
Tokyo 1520021, Japan2
Department of Informatics, Shizuoka University, Japan
3
Graduate School of Informatics, Kyoto University, Japan
4
University of Montpellier, France
5
Institut Gineste-Marescotti, France*Corresponding author (Miwako Honda, MD, e-mail: honda-1@umin.ac.jp)183

ASM Science Journal, Special Issue 2017(1) ICT-Bio

Introduction
Dementia is a progressive, incurable illness. Among patients with advanced dementia, the final year of life ischaracterised by a trajectory of persistently severe disability1. Behavioural and psychological symptoms of dementia(BPSD) encompasses a range of symptoms including agitation, aggression, delusions, hallucinations, depression
and apathy2. BPSD is a key challenge in dementia care for both patients and caregivers3 and the typical difficulty isa refusal of care. This results in a poor quality of care to patients and leads to a poor quality of life.
The multimodal comprehensive care—Humanitude®—is a French-originated methodology for vulnerable
elderlies focusing on their perception, emotions, and oral communication4, 5. This methodology has 38 years of clinicalexperience in France and other European countries. In a previous study, the effectiveness of this methodology
was compared with conventional care. It showed a significant reduction of BPSD among dementia patients in along term care facility compared to conventional care, and a reduction of burnout in professional caregivers who
performed Humanitude® care6, 7. As the next step, the development of an effective education and evaluation systemfor caregivers with this methodology is needed. The aim of this study was to evaluate the differences between
conventional care and Humanitude® care, and to verify the validity of the analysis of care by informatics.

Methods
Four professional caregivers were enrolled in the study. Two had been trained to perform Humanitude® care and theothers were to perform conventional care. Two residents with dementia in a nursing home agreed to participate thestudy. The consents were obtained from all the caregivers, nursing home residents and their families.
The caregivers performed oral care and walking assistance for the patients. The care was video-recorded by
two methods. One was handy video camera by researchers as the third person camera. The other was a builtin camera in the frame of the glasses that the caregivers wore during the care, as the first person camera. The
video was analysed from the point of view of the fundamental principles of care communication; three elementsof communication modalities: eye contact, verbal communication, touch. The comprehensiveness of these threeelements was also analysed. Analysis was done manually by researchers specialising in artificial intelligence andautomatically by informatics analytical software.

Results
Two types care records were analysed; one was by the third person camera and the other was by the one person
camera. Table 1 shows the comparison between conventional care and Humanitude®, in oral care and walking
assistance for dementia patients. The video used for this analysis was recorded by the third person camera. The
modality of communication and interaction elements; eye contact, verbal communication and touch during the oral
care were 0%, 20%, 0% by conventional care, and 38%, 35%, 50% by Humanitude® care respectively. In walking
assistance, the modalities; eye contact, verbal communication and touch were 0%, 40%, 0% by conventional careand 13%, 22%, 36% by Humanitude® respectively. There was a significant difference in two groups (p<0.05).
The definition of comprehensiveness of care is to perform more than two modalities of care simultaneously (eg.
eye contact and touch, verbal communication and touch, or all of them). The comparison of comprehensiveness ofinteraction was done by the third person camera analysis. The result is described in Table 2. In conventional care, thecomprehensiveness in oral care and walking assistance was 0%, which meant the caregivers used only one modalityof communication during the care. In Humanitude®, 40% of the care had more than two modalities. There was also
a significant difference between the two care methodologies.
The video recorded by the first person camera was also analysed and the results are summarised in Table 3.
The caregivers performed oral care and walking assistance for the patient. The duration of care was 70,583 frames(2,367 seconds) in conventional care and 53,258 frames (1,786 seconds) in Humanitude®. The eye contact recordedby the first person camera was 3.7% (2,617 frames) for conventional care, while the caregivers using Humanitude®

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Miwako Honda, MD et al.: A Video-based Education and Analysis System

performed 30.7% (16,007 frames) eye contact. In verbal communication, the talk was 26.2% (18,493 frames) inconventional care and 55.3% (29,452 frames) in Humanitude®.
A comparison of manual analysis and auto-video analysis was carried out. The oral care was recorded by thefirst person camera. In the auto-video analysis, the frames to recognise eye contact was 0.113% (80 frames) byconventional care and 39.3% (2,0952 frames) by Humanitude®, while manual analysis was 3.7% (2,617 frames) and30.1% (16,007 frames) respectively (Table 4).

Discussion
People living with dementia are increasing in an aging society. The total number of people with dementia worldwide
in 2015 was estimated at 47.5 million8. Dementia is progressive and incurable, so to provide adequate care is
the key for its management. Thr multimodal comprehensive care methodology Humanitude® is one of the nonpharmacological care approaches for this challenge. A previous study showed the effectiveness of Humanitude® forthe management of BPSD.
In this study, comparisons between conventional care and Humanitude® were conducted. The uniqueness ofHumanitude® was its multimodal comprehensiveness, using eye contact, verbal communications, touch and assistancefor erectile positions. This study focused on three elements of modalities; eye contact, verbal communication andtouch. There was a significant difference in the modalities and its comprehensiveness between conventional care andHumanitude®. The results in Table 1 showed that even if conventional caregivers believed “I am seeing the patient”,
there was no eye contact to communicate with the patients. Caregivers touched patients during the care, however,
our study suggested it focused more on “duties they had to complete”, and lacked the aspect of communication. The
comparisons of comprehensiveness in Table 2 showed no inter-modality comprehensiveness of communication inconventional care. This tendency was also oberved in the video taken by the first person camera. These results could
be used for the evaluation of care, and further, as education for the caregivers.
Table 1. Time used for each modality of interaction during the care
A: Oral carep<0.05Eye contact

Talk

Touch

Conventional care

0%

20%

0%

Humanitude®

38%

35%50%

B: Walking assistance

p<0.05Eye contact

Talk

Touch

Conventional care

0%

40%

0%

Humanitude®

13%

22%

36%

Table 2. Inter-modality comprehensiveness during the care
Eye contactp<0.05Walking assistance

Conventional care

0%0%Humanitude®

40%

22%

Because the global need for caregivers has increased, a high quality of training is crucial. An automated analysis
system of care was evaluated in this study and it had the same tendency as manual video analysis. This suggested
that auto-video analysis could be applied to the teaching of caregivers so that the scale of training would be able toexpand. It would lead to standardised training for caregivers and thus, reduce the training cost.

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ASM Science Journal, Special Issue 2017(1) ICT-BioTable 3. First person camera analysis of careeye contact (Frames)(% of care)

Walking assistance(Frames)(% of care)

Conventional care
70,583 frames(2,367 seconds)

2,617(3.7%)

18,493(26.2%)

Humanitude®
53,258 frames(1,786 seconds)

16,007(30.1%)

29,452(55.3%)

Table 4. Comparison of eye contacts during oral care by manual and auto video analysis
Manual analysis

Auto analysis

Conventional care

3.7%

0.113%

Humanitude®

30.1%

39.3%

Finally, this study was conducted in collaboration with French institutions. The expansion of collaboration with
Asian countries would contribute globally to improve the quality of life of elderlies globally.

Conclusion
Video analysis showed significant differences in the comprehensive multimodal care methodology Humanitude® andconventional care. Auto-video analysis would be effective in a standardised training of caregivers and would reduce
the training cost.

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